Groinage pain while skinning

I've been experiencing pain in approximately this area, in particular when raising my right knee upward. So, skinning uphill causes lots of discomfort. So does hiking and even MTB after about 12 miles. I always start off feeling good, then steadily deteriorate to maybe a 4 or 5 out of 10 pain. No scrinching sound/feeling like with tendonitis.

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Questions:

Any idea what the problem is? I'm guessing muscular, but I really don't know.

Any ideas what to do? Not interested in going to a doctor's office during a pandemic. I'm sure the answer is "rest" but I wanna ride my bike.

subscribed. same problem here.

I had pain in that area years ago. It used to bother me when high-stepping with my right leg while rock climbing. I think I high-stepped too high once and pulled the muscle. Anyway I actually went to the doc and said "It hurts when I do this," and lifted my leg. He gave me the classic reply, "Then don't do that." I believe it went away after like 6 months of not doing that.

I had pain towards the front of my right hip when touring / hiking. Was an impingement. Had surgery. Right as rain now.


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I know this pain. Don't know what to call it but I have some floor stretches that cure it.

(I was gonna ask if you'd been skiing with mtn girl, then I saw the picture.)

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Originally Posted by yeahman

I had pain in that area years ago. It used to bother me when high-stepping with my right leg while rock climbing. I think I high-stepped too high once and pulled the muscle. Anyway, I actually went to the doc and said "It hurts when I do this," and lifted my leg. He gave me the classic reply, "Then don't do that." I believe it went away after like 6 months of not doing that.

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Don't you hate it when you hear that?

Groin pain can be a myriad of things ranging from hip joint issues to a hernia. You'll have to have one of those global disclaimers about getting health advice from TGR.

The thing to note is that actual hip joint (femoral head and acetabulum - the ball and cup respectively) pain is often felt in the groin, not on the outside which we colloquially think to be our hip. A way to test this is flex your hip to 90 degrees and then rotate your foot outwards (i.e., hip flexion and internal rotation of the hip joint). It may be easier to lie on your back and have someone else do it to you and compare both sides. If the pain is recreated it may be coming from the actual hip joint. Notably, a tendinitis can occur to the iliopsoas tendon which runs anterior to the hip capsule, though much less common than issues with the hip joint itself, but it's pretty deep and you wouldn't necessarily feel "scrinching" (to use your words).

Wow. Thanks, Orthoski for the insight, both in naming that iliopsoas tendon and pointing out it could be hip issues. The stretches I do that cures that pain for me are hip joint related. Of course, it comes back at random intervals. My last MRI reading noted that my hips have a bit too much wear and tear. However, I have also felt a pain in the iliopsoas tendon and have never be able to put a name on it.

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Originally Posted by Orthoski

Groin pain can be a myriad of things ranging from hip joint issues to a hernia. You'll have to have one of those global disclaimers about getting health advice from TGR.

The thing to note is that actual hip joint (femoral head and acetabulum - the ball and cup respectively) pain is often felt in the groin, not on the outside which we colloquially think to be our hip. A way to test this is flex your hip to 90 degrees and then rotate your foot outwards (i.e., hip flexion and internal rotation of the hip joint). It may be easier to lie on your back and have someone else do it to you and compare both sides. If the pain is recreated it may be coming from the actual hip joint. Notably, a tendinitis can occur to the iliopsoas tendon which runs anterior to the hip capsule, though much less common than issues with the hip joint itself, but it's pretty deep and you wouldn't necessarily feel "scrinching" (to use your words).

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Hey - I can use your words too!

Crepitus.

Idiopathic cardiopulmonary encephalitis.

Doppler effect.

See?

Just kidding. Thanks for the (I'm assuming authentic) medical perspective on this. I now think it's the actual hip joint. That little leg rotation test you described recreates the pain, particularly when i rotate my hip back to normal position. There are a few other reasons that make me think it's the joint, not muscular... Fack.

Welp, surgery in the summer is better than in the middle of ski season. To all the other groin gimps in this thread - best of luck to you.

It’ll obviously depend on the surgery, but for what it is worth, I got my hip operated on in mid-late August and was on skis by December... much faster than this stupid Achilles rehab.


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Originally Posted by dangur

Hey - I can use your words too!

Crepitus.

Idiopathic cardiopulmonary encephalitis.

Doppler effect.

See?

Just kidding. Thanks for the (I'm assuming authentic) medical perspective on this. I now think it's the actual hip joint. That little leg rotation test you described recreates the pain, particularly when i rotate my hip back to normal position. There are a few other reasons that make me think it's the joint, not muscular... Fack.

Welp, surgery in the summer is better than in the middle of ski season. To all the other groin gimps in this thread - best of luck to you.

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Way too soon to be thinking about surgery. Notice that orthoski said it MAY be coming from the hip joint. An xray will help. Groin pain is common. Doesn't sound like a hernia, but it could be. Musculotendinous, like orthoski mentioned. And whether you want to hear it or not, a lot of these problems respond to rest, and only rest.
By the way, the muscles you circled are adductors--they bring your knees together. They start in the obturator foramen which is the hole in the middle of the bone you sit on (the ischium)--so farther back and lower down then where you pain is.

see a doc, get examined, get an xray.

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Originally Posted by bw_wp_hedonism

It’ll obviously depend on the surgery, but for what it is worth, I got my hip operated on in mid-late August and was on skis by December... much faster than this stupid Achilles rehab.

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Funny you mention Achilles surgery. I got what OP is describing trying to ride a stationary bike with the boot on after surgery. Unequal leg length due to the boot caused a bunch of pain in the groin.

PT put me on a series of stretches for hamstrings and low back. Those stretches, plus taping a block of wood to the other pedal to equalize leg length, made the pain go away after a few weeks.

Unfortunately, resurrecting this one...
So I got a hip impingement (what orthoski describes above) diagnosis last summer. It was painful, but intermittent. I was planning on getting a cortisone shot in Jan and getting through this ski season, then prob needing surgery. Given age (49), that would prob be full hip replacement vs clean up of the femural head and/or cartilage. Unfortunately, 7 ski days in this season, it's only worsened and now is regularly painful and skiing quickly results in a jolting pain. I'm guessing I've also now damaged labrum or cartilage and it's right on a nerve or something. Just day to day stuff is regularly painful, with bouts of stabbing/jolting pain. With all that...
- Anyone else gone through this?
- Any chance a cortisone shot would help? I thought those were more for inflammation vs acute pain
- I've done all kinds of daily exercises and stretching which has helped the peripheral issues like stiffness in lower back... but I can't imagine PT can help with the hip issue itself... so is some form of surgery likely the only path?
- Any experience with surgical clean up vs full hip replacement?
I do have an ortho appt scheduled for next week, but would love to get anyone's experience here! Thx!

I had pain on the out side of the hip to the point I can't really paddle a kayak anymore cuz the legs don't like to splay out sideways and it was getting painful to tie my shoes

so how it went is they took xrays, said the hip is ok but suspect the labrum so did an ultra sound, said the labrum is OK but the bursa of the iliopsoas looked inflamed, SO do you wana try a steroid ( deponedrol ) or let the PT work on it ?

So I got the shot, they watch/ do it on the ultra sound so the needle doesnt hit anything, ( there is a vid of that procedure on-line) MD also suggested a heavier course of IBU which I don't usually take and that helped also

I definatly now have more range before reaching the point where it starts to hurt but I am painfree in normal life for the most part,

PT gave me a stretch where I bring the knee of the bad leg towards my opposite shoulder

skinning up seemed to hurt and skiing hurts the other knee with new acl on the way down but I haven't quit skiing

got rid of all the kayaks but I still wear shoes

Interesting, thx xxx-er. Yes, I simply can't kayak - that position is really no bueno. I can see the shot helping ease a bursa. Wonder what they say on the shot against torn labrum, which I'm pretty sure I've got.
I'm starting to scramble for replacements on a few cat and BC trips. I just don't see how I can get through the season, especially intense back to back days. Oh well, I've had a good run!

I assume the pro's would go xray/ ultrasound/ injection in the same order as they did me, it seemed like the logical path of HC as they went about it instead of winging it

yeah it sounds like a no go for the Cat & BC trips for this year, but I wouldn't count your self out completely just yet, ever one is differeent, my 50's were my best skiing, the best shape eva was probably 56

^^^ Again, encouraging, thank ya. Yeah, I'm actually optimistic on my future years. Was prob due for some injury. But glad that the hip has a pretty high success rate procedure that could put me back in good order. To the ortho we go...

I am not a doctor, this isn't medical advice, etc.

Torn labrum can usually be diagnosed with MRI (mine was with contrast).

I badly tore my labrum playing soccer when I was like 16. 100% acute, not overuse or degeneration. After misdiagnoses for several years, I ended up having surgery (labral debridement). Earlier is better if you really need surgery, and I would definitely insist on repair vs debridement if possible. My hip will never be 100% the same, but I can definitely live with it compared to how I felt before surgery.

That said, stretching and strengthening go a LONG way for FAI (femoroacetabular impingement).

Things I would consider before surgery:
- a serious daily strength and mobility routine. Work on strength through the full hip ROM, including the end ranges where most people lack strength. Strength is key here, not just stretching/mobility. If you sit at a desk all day, you likely have tight, weak hips. Fix that first, and it will only help if you end up needing surgery.
- massage directly on the affected painful tissues. I can't believe how much this has helped me. If you can find a good PT who has experience with manual therapy on the abdomen, this can be a game changer. I never would have believed how much tension in my abdomen could impact pain in my groin.
- PRP or stem cell injection (not cortisone. YMMV not trying to start a debate on the clinical efficacy of orthobiologic vs steroidal injection).
- if you've been in chronic pain for a while, you'll want to try things to reset that. Anti-inflammation diet, cold-water immersion, etc.

I'm not sure any of these would have fixed my acute, bad labral tear, but they have all substantially helped with subsequent pain in both my hips (and other injuries).

Also very helpful. Yeah, I've got a pretty good daily routine that has helped alot with all the peripheral issues. Not daily, but bi weekly dry needling has also helped ease alot of the tightness in my upper quad, IT, lower back on that side. But I like the sound of stem cell and cold immersion - will look into those. I've generally been anti-surgery so prob worth exploring/exhausting most of non-surgical first, especially near-term to see if I can salvage the season. (Plus shitty high deductible insurance.) Still trying to get out of trips to de-risk the cost. Anyway, helpful and thanks again!

Quote:

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Originally Posted by tang

Unfortunately, resurrecting this one...
So I got a hip impingement (what orthoski describes above) diagnosis last summer. It was painful, but intermittent. I was planning on getting a cortisone shot in Jan and getting through this ski season, then prob needing surgery. Given age (49), that would prob be full hip replacement vs clean up of the femural head and/or cartilage. Unfortunately, 7 ski days in this season, it's only worsened and now is regularly painful and skiing quickly results in a jolting pain. I'm guessing I've also now damaged labrum or cartilage and it's right on a nerve or something. Just day to day stuff is regularly painful, with bouts of stabbing/jolting pain. With all that...
- Anyone else gone through this?
- Any chance a cortisone shot would help? I thought those were more for inflammation vs acute pain
- I've done all kinds of daily exercises and stretching which has helped the peripheral issues like stiffness in lower back... but I can't imagine PT can help with the hip issue itself... so is some form of surgery likely the only path?
- Any experience with surgical clean up vs full hip replacement?
I do have an ortho appt scheduled for next week, but would love to get anyone's experience here! Thx!

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I've been going through a very similar thing for the past few years and am currently laid up in bed following a hip resurfacing surgery last week.

For more years than I can remember I've had some groin pain and hip tightness but it was always more of a niggling injury, lingering in the background. I did see my physio about it off and on, but always in between more pressing and acute injuries that took more of my focus. Come 2020 it started becoming a lot more troublesome so I ramped up my physio programme. After a few months of hard work with zero progress and worsening pain, my physio told me he was sure I had some mechanical impingement in the joints and it was time to get an X ray to see what was up.

My X ray results came back with a diagnosis of advanced OA in my right hip and moderate OA in my left left hip, both caused by cam type femoroacetabular impingement. I was referred to a surgeon as the damage was too far gone for much else than joint replacement, leaving me with a long and painful wait for a consultation (I'm in Banff, Alberta, and mid-pandemic wait times for hip surgeries have been fucked here). As things continued to deteriorate, I had to give up more and more activities: touring, football (the soccer one), hiking, kayaking etc. I was still downhill skiing and biking, but only by gritting my teeth and relying on painkillers, and having to do shorter days with more rest days in between.

Whilst waiting for my initial surgeon referral to be processed, I started doing a ton of research as being told I needed new hips in my late thirties was a tough pill to swallow. After much reading it seemed like hip resurfacing/Birmingham hip replacement was my best option if I wanted to continue with unrestricted activities, as well as still allowing an easier revision to a total hip if needed later in life. Hip resurfacing surgeons are few and far between as it's a more technically challenging procedure to get right compared to a total hip. The results from the doctors who do high volumes of them are outstanding though. Thankfully we have a couple of surgeons here in Calgary who specialise in resurfacing, and I was deemed a viable candidate. I just got my right hip done last week and will get my left one done in the next year or two depending how much longer it lasts. It's early days yet but I'm stoked to have had the shitty hip cut out and am excited to start the rehab journey with the possibility of skiing pain free again for the first time in a long time.

Whilst waiting for my surgery my sports doc had recommended a hylauronic acid injection (Durolane). He said they work great for some people, less well for others, and tend to be less effective the more advanced your arthritis is. I got one and had mixed results - it gave me some brief respite but as soon as ski season started again the pain came back full force. My wife on the other hand had much better results. It gave her about a year's worth of pain relief, allowing her to maintain some activity levels before getting her hip surgery.

Anyway best of luck, let me know if you have any questions.

^^^ Spooky, first sorry bout your years of pain and reduced activity but good news on being a resurfacing candidate and getting that done. Will you be back for late season? What’s recovery time typically? I think I’m past that option. But did get the cortisone shot yesterday- hoping that eases things for a few months. And a long skin day went fine the other day. I think resort (slashing around in trees, moguls) is most problematic, not surprising.
Heal fast!

I have FAI with a cam as well as a torn labrum. I was diagnosed a few years ago but it wasn't at all clear if I was a candidate to get the femoral head smoothed out along with the labral tear fixed. It seems like those surgeries have a 50/50 track record, and if it doesn't work, then you've spent all that time and effort just to get a hip replacement. So I've been putting up with it.

I would echo what auvgeek said about finding a PT that's really really good at hips. I saw someone years ago, and I think she's good at general PT, but it didn't do anything and she tried it all, including dry needling. Fast forward to this season- I was trying to get some miles early season so I'd be in shape when the good stuff opens, but that meant I was pounding bumps and I wasn't doing great.

A friend said I needed to go see her PT who really tries to specialize in hips. She's been working on the muscles you don't think about, like the pelvic floor, psoas, etc. And she's been digging deep into that whole zone, she even said, "ok, now I'm going to pretend your pelvis is a crimper hold on a climbing wall". I felt really good today, first time in a long time. Right now I feel like I'm buying some time.

Also of note- orthobionomy tends to make me feel pretty good for 3-5 days. Worth trying for sure.

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Originally Posted by Spooky

After much reading it seemed like hip resurfacing/Birmingham hip replacement was my best option if I wanted to continue with unrestricted activities, as well as still allowing an easier revision to a total hip if needed later in life. Hip resurfacing surgeons are few and far between as it's a more technically challenging procedure to get right compared to a total hip. The results from the doctors who do high volumes of them are outstanding though. Thankfully we have a couple of surgeons here in Calgary who specialise in resurfacing, and I was deemed a viable candidate. I just got my right hip done last week and will get my left one done in the next year or two depending how much longer it lasts. It's early days yet but I'm stoked to have had the shitty hip cut out and am excited to start the rehab journey with the possibility of skiing pain free again for the first time in a long.

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BHR’s a good option since you are so young and have good surgeons nearby. But not many surgeons do them often anymore and you want someone who’s done 500+.
I don’t think anyone at Steadman does them at all.

I did THR anterior approach 11 years ago at 53. It’s been pretty bomber so far.


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Makes sense. I’m gonna dig in on finding a good hip PT. Mine has been good for dry needling (which has helped the peripheral tightness) but otherwise is a generalist.

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Originally Posted by Shredhead

BHR’s a good option since you are so young and have good surgeons nearby. But not many surgeons do them often anymore and you want someone who’s done 500+.
I don’t think anyone at Steadman does them at all.

I did THR anterior approach 11 years ago at 53. It’s been pretty bomber so far.


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Yeah I’ve been super lucky in that regard - the two Calgary based surgeons who do them have both done 1000+ so I trusted I was in good hands for this option. I know of people who have traveled abroad to get it done privately due to lack of available surgeons who do them.

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Originally Posted by tang

^^^ Spooky, first sorry bout your years of pain and reduced activity but good news on being a resurfacing candidate and getting that done. Will you be back for late season? What’s recovery time typically? I think I’m past that option. But did get the cortisone shot yesterday- hoping that eases things for a few months. And a long skin day went fine the other day. I think resort (slashing around in trees, moguls) is most problematic, not surprising.
Heal fast!

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Thank you! I doubt I’ll be skiing this season - the usually recommendation after resurfacing is 6-12 months before returning to impact sports as your bone needs to grow into the implants. I’ll see what my surgeon says at my follow ups. I’m also recovering from a double Achilles rupture and surgery for that so need to spend a lot of time with my physio getting my body sport ready again. Main aim at the moment is to get some strength back ready for bike season. Good luck with yours, I hope the shot gives you some good relief for a while.

I can chime in here as well, i have been diagnosed with impingement and torn labrums on both sides, my experience with this lines up with goldenboy - the FAI surgery has a pretty poor track record, i went to 3 different orthos locally and none of them offered it as a solution for me - i also had reasonable cartilage in the joint - my understanding is how much cartilage that is left in the joint is the deciding factor for replacement surgery

i worked with a very good physiatrist - we did PRP for the tears and some entrapped nerves, trigger point therapy in the muscles around the hip where i had tender spots, i went through a whole bunch of PTs as well - i would say my experience with the PTs was more mixed than i would have liked - a few of the other things that i learned that i think are important - if you have pain in the front of the hip - stretching that area is likely to be counterproductive, several of the glute muscles attached to the back of the femoral head, strengthening them will pull the femoral head towards the back of the joint thus reducing the impingment, going to a range that 'hurts' likely makes things worse, cycling, skinning up and moguls can be tough if you are in the acute pain phase - i had a lot of success going this route - i dont have any real pain anymore

i've worked with a MAT practitioner for a couple years now - all my pain was cleared up by this time I started - but the working theory is a little different than most therapies - you get tight where there is weakness, treating the muscle to be stronger at the end of range will increase mobility

i was pretty aggressive trying to avoid surgery - i'm currently 50 and this stuff started 7-8 years ago, my father had his hip replace 3xs so i'm trying to avoid that fate

I have been dealing with hip pain for 18 months. It started suddenly, while I was putting in a boot pack at work (full time ski patroller) and never seemed to go away. I tried to rest it, PT and strengthening and the pain would subside for a bit, but nevertheless I’d tweak it and it would bother me for another couple of weeks. It got to the point where I wasn’t skiing much, no touring and I stopped trail running. Interestingly the only activity that didn’t bother it was WW kayaking.

I finally went to my Ortho and had an MRI done with contrast. It showed a pretty badly torn Labrum in the hip. Doc said if I was older they would just do a replacement, but at my age (39), the labrum repair was a better option. So here I am, 4 days after surgery, sitting on the couch waiting to feel better. Not sure how much I’m gonna be on skis this winter but hopefully next summer I’m 100% ready to go. Luckily for me I live near Jackson WY so was able to find a surgeon who has been doing these their entire career.

Hmmm, with hip issues sitting in a kayak was the main problem so I'm suprised WW kayaking was ok for you, doing an mri they found an inflamed Iliopsois bursa on the outside of my hip but the hip & labrum were ok

I couldn't sit in a boat for > an hr with my legs splayed outwards but I'm old so I just gave up kayaking and sold all the boats

it was also hurting on the up track last winter so i'm hoping I won't have to give up ski touring

Different "hip" issues cause different symptoms, have different aggravating and alleviating factors.

I had a torn labrum a few years ago. Ended up getting the diagnosis after I went to doc bc I couldn’t hike in summer/skin in winter. They did a repair (the other option I was given was to cut it out).

Operation in August, was back on skis going easy in December. I still feel tightness occasionally, but a bit of yoga makes that go away real quick. Now back to damn near 100%.


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Got super tight hips and groin. Been working on lots of wall yoga. Pidgion pose. Doing leg swings and donkey kicks. Butterfly. Chair pose. Figure 4. Can sit crisscross apple sauce moderately comfortably.

Also, using daily hydration enhancers.

Goal is to be able to do a much more slow and comfortable kickturn with the transitioning ski actually perpendicular to the fall line and no need to transition quickly because it hurts so damn bad.